Katano Takuma, Tsuzuki Toyonori, Numanami Hiroki, Sassa Naoto, Kato Toshio, Kubo Akihito, Ito Satoru
Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Japan.
Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan.
Respir Med Case Rep. 2022 Jul 31;39:101716. doi: 10.1016/j.rmcr.2022.101716. eCollection 2022.
Pulmonary tumor embolism (PTE) is difficult to diagnose before death. We report the case of a 75-year-old man with microscopic PTE of renal cell carcinoma who was diagnosed by surgical lung biopsy. He visited our hospital because of dyspnea on exertion. Chest computed tomography (CT) showed multiple micronodules and ground glass opacities. Steroid therapy was started as therapeutic diagnosis for IgG4-related pulmonary disease. However, he was admitted our hospital due to progressive respiratory failure. Pathological findings of a lung biopsy obtained by video-assisted thoracic surgery showed PTE of renal cell carcinoma without embolization of large pulmonary arteries. He received palliative medicine and died four months after the surgical lung biopsy. In cases of multiple micronodules in chest CT findings and worsened respiratory symptoms, PTE should be considered in the differential diagnosis.
肺肿瘤栓塞（PTE）在生前很难诊断。我们报告一例75岁男性肾细胞癌微小PTE病例，通过手术肺活检得以确诊。他因劳力性呼吸困难前来我院就诊。胸部计算机断层扫描（CT）显示多个微小结节和磨玻璃影。开始使用类固醇疗法作为IgG4相关肺部疾病的治疗性诊断。然而，他因进行性呼吸衰竭入住我院。电视辅助胸腔镜手术获取的肺活检病理结果显示为肾细胞癌的PTE，无大的肺动脉栓塞。他接受了姑息治疗，在手术肺活检四个月后死亡。对于胸部CT表现为多个微小结节且呼吸症状加重的病例，鉴别诊断时应考虑PTE。
